A programme of inspections by the Care Quality Commission (CQC) has found continued concerns about the quality of NHS hospital maternity services with common issues impacting on safety at services across the country.
In a report published today (Thursday 19 September) CQC presents the findings from its recent national maternity inspection programme and calls for action now to avoid poor care and preventable harm becoming normalised.
Between August 2022 and December 2023, CQC inspected 131 maternity units as part of a targeted programme to assess all hospital maternity locations that had not been inspected and rated since March 2021. The programme was carried out to provide an up-to-date view of safety and quality across England and to unpick and help address the lack of progress at some hospitals.
While CQC found some examples of good practice, of the 131 maternity units inspected just under half (48%) were rated requires improvement or inadequate ‘overall’. Around a third (35%) were rated good for ‘safety’. However, ‘safety’ standards at all other units inspected were rated either requires improvement (47%) or inadequate (18%) and CQC found significant variation in the way trusts operated in key areas such as learning from incidents and assessing women at triage to identify any risks.
CQC’s National review of maternity services in England 2022-2024 sets out the main themes from the inspection programme as a whole and draws on feedback from families about their experience of using maternity services. It points to examples of good care but also highlights common areas of concern impacting on the quality of care for women and babies at some hospitals. Based on its findings, CQC has made recommendations for NHS trusts, the wider system and national bodies to support vital improvements.
Although CQC saw that some services managed safety incidents well, in others they found that incidents of serious harm were not reported or were graded inconsistently, meaning that opportunities to investigate and learn were missed. Inspectors raised concerns that some services tended to accept maternity incidents as inevitable or failed to report them due to time constraints caused by staffing pressures.
While recognised complications in pregnancy may be common for staff and do not always constitute a reportable ‘patient safety event’, they can have a significant and long-lasting impact on those experiencing them. Feedback from women using services highlighted the particular impact on their mental health. Inspectors found that this was not always a factor considered by services and many had no way of monitoring and responding to trends in commonly occurring obstetric complications at a local level.
Ensuring timely and effective risk assessment at triage was also a concern. Issues with staffing and the triage environment resulted in delays; and for some women, the wait to be assessed at triage was so long that they chose to discharge themselves before being seen.
Some maternity units assessed as part of the programme were not fit for purpose, as they lacked space and facilities and, in a small number of cases, appropriate levels of potentially life-saving equipment. Women should receive safe, timely care in an environment that protects their dignity and promotes recovery. CQC is calling for additional capital investment for maternity estates and assurance that money will be ring-fenced and spent where it is intended to improve the safety of maternity environments.
Additionally, the inspection programme revealed significant differences in the way trusts collect and use demographic data to address health inequalities. At some trusts, both staff and people using the service experienced discrimination because of their ethnic background, or issues associated with having English as a second language. And communication with families more broadly was not always good enough, with more work required to ensure all women are given the information they need, in a way they understand it, to make informed decisions and consent to treatment. Families can also have a crucial role in supporting improvements and should have the opportunity to directly input their experience and expertise to help co-produce improvement initiatives.
Nicola Wise, CQC’s Director of Secondary and Specialist Care, said:
Sadly, our latest maternity inspection programme has further evidenced the need for urgent action with continued problems indicating that the failings uncovered in recent high-profile investigations are not isolated to just a handful of individual trusts.
Although we’ve seen examples of good care and seen hardworking, compassionate staff doing their best, we remain concerned that key issues continue to impact quality and safety. Disappointingly none of those issues are new; poor management of incidents with limited learning when things go wrong, failure to ensure safe and timely assessment, unsuitable estates and access to essential equipment, a lack of oversight from trust Boards, varied efforts to tackle inequalities in outcomes for Black and ethnic minority women, chronic staffing shortages and a need for better engagement with families.
While some of those things are within the power of hospital leaders to address, there are others that require increased national action and additional capital investment, with money ring-fenced for safer maternity services spent where it will make a difference.
We cannot allow an acceptance of shortfalls that are not tolerated in other services. Collectively, we must do more as a healthcare system. This starts with a robust focus on safety to ensure that poor care and preventable harm do not become normalised, and that staff are supported to deliver the high-quality care they want to provide for mothers and babies today and in the future.
Today’s report sets out CQC’s recommendations for NHS trusts, Integrated Care Boards (ICBs) and wider system partners to help address the issues identified as part of the inspection programme and support critical improvements for those using and working in maternity services across the country.
Alongside the report CQC has worked with providers, maternity staff and stakeholder organisations to develop some additional resource materials. These resources are available on CQC’s website and are aimed at maternity service staff at all levels to help support their efforts to deliver high quality care and make improvements where needed.